INTERIM GUIDELINE FOR

HUMAN RABIES
PREVENTION &
CONTROL IN MALAYSIA
Disease Control Division
Ministry of Health Malaysia

INTERIM GUIDELINE FOR PREVENTION AND CONTROL OF

RABIES IN MALAYSIA

INTRODUCTION
Dog bites are traumatic and dangerous events, representing a high probability of infection-especially if the bite goes untreated. A dog's saliva has a broad diversity of bacteria. In
almost 100% of dog bites, harmful bacteria and other dangerous pathogens are present and
can be transmitted to the bite wound. Signs that a dog bite has become infected include
redness, pain and oozing. Generally, the management of dog bites depends on the location
of the bite, the overall health condition of the bitten person and whether or not the dog is
vaccinated against rabies. Most dog bite wounds can be managed in the general practice
setting. However, it is important to recognize when a wound is at high risk of infection and
when referral to hospital is required.
The most feared complication of an animal bite is rabies, although skin infection is the most
common complication. Some bite wounds can be serious, causing injury and permanent
disability. Bite wounds to the hand carry an especially high risk for serious complications
because the skin's surface is so close to the underlying bones and joints.
Rabies is a zoonotic disease (a disease that is transmitted to humans from animals) that is
caused by a virus. The disease infects domestic and wild animals, and is spread to people
through close contact with infected saliva via bites or scratches. Rabies is present on all
continents with the exception of Antartica, but more than 95% of human deaths occur in Asia
and Africa. Once symptoms of the disease develop, rabies is nearly always fatal. Rabies is
widely distributed across the globe, with only a few countries (mainly islands and peninsulas)
being free of the disease. Many animal species are involved in the maintenance and
transmission of the disease in nature.
MODES OF TRANSMISSION
People are infected through the skin following a bite or scratch by an infected animal. Dogs
are the main host and transmitter of rabies. They are the source of infection in all of the
estimated 55 000 human rabies deaths annually in Asia and Africa. However, bats are the
source of most human rabies deaths in the United States of America and Canada. Human
deaths following exposure to foxes, raccoons, skunks, jackals, mongooses and other wild
carnivore host species are very rare.
Transmission can also occur when infectious material usually saliva comes into direct
contact with human mucosa or fresh skin wounds. Human-to-human transmission by bite is
theoretically possible but has never been confirmed. Rarely, rabies may be contracted by
inhalation of virus-containing aerosol or via transplantation of an infected organ. Ingestion of
raw meat or other tissues from animals infected with rabies is not a source of human
infection.

CLINICAL MANIFESTATIONS
The incubation period for rabies is typically 13 months, but may vary from <1 week to >1
year.
The initial symptoms of rabies are fever and often pain or an unusual or unexplained tingling,
pricking or burning sensation (paraesthesia) at the wound site. As the virus spreads through
the central nervous system, progressive, fatal inflammation of the brain and spinal cord
develops.
Two forms of the disease can follow. People with furious rabies exhibit signs of hyperactivity,
excited behaviour, hydrophobia and sometimes aerophobia. After a few days, death occurs
by cardio-respiratory arrest.
Paralytic rabies accounts for about 30% of the total number of human cases. This form of
rabies runs a less dramatic and usually longer course than the furious form. The muscles
gradually become paralyzed, starting at the site of the bite or scratch. A coma slowly
develops, and eventually death occurs. The paralytic form of rabies is often misdiagnosed,
contributing to the underreporting of the disease.

PREVENTION AND CONTROL OF RABIES IN MALAYSIA

1. Surveillance of human rabies

1.1

CASE DEFINITIONS
1.1 Human Rabies
Clinical case definition - A person presenting with an acute neurological syndrome
(encephalitis) dominated by forms of hyperactivity (furious rabies) or paralytic
syndromes (dumb rabies) progressing towards coma and death, usually by
respiratory failure, within 7-10 days after the first symptom.
It is further classified into;
1)

Suspected: A case that is compatible with the clinical case definition and with
history of dog bite or scratch.

2)

Probable: A suspected case plus history of contact with a suspected rabid

dog.

3)

Confirmed: A case that is laboratory-confirmed.

1.2 Human Exposure to Rabies

It is further classified into two (2) groups;

1.2

1)

Possible exposure: A person who had close contact (usually a bite or scratch)
with an animal displaying clinical signs consistent with rabies at time of the
exposure, or within 10 days following exposure in rabies infected area.

2)

Exposed: A person who has had close contact (usually a bite or scratch) with
a laboratory confirmed rabid animal

NOTIFICATION

For the purpose of investigation and further action, all suspected, probable and confirmed
cases (including dog bite cases human exposed to suspected rabid dog/animal) must be
notified to the nearest Health District Office (PKD) within 24 hours of the date of diagnosis by
respective hospital/clinic (Annex 1a). PKD must notify the nearest District Veterinary Office
immediately by phone followed by submission form (Annex 1b) through fax. Then, District
Health Office should further do these actions;

Case should be referred to nearest hospital for evaluation and further action
(management of case/patient).
Notification of dog bite cases can be done using Annex 1a.
All notified cases must be investigated.
Within 48 hours, a rabid dog status should be clarified with the Veterinary District
Office.
Daily reporting is closed by 5.00 pm every day. Daily line listing and report should be
submitted to JKN by respective PKD not later than 10.00 am the next day. JKN
should submit daily report to KKM before 12.00 pm the next day via email:
zoonosis@moh.gov.my.

Please refer Appendix 1: Carta Alir Pengurusan/Tindakan Kes Gigitan Anjing/Haiwan Liar
which summarizes the above actions;
a) Annex 1a: Borang Notifikasi Kes Gigitan Haiwan yang Membawa Penyakit Rabies
(hospital/clinic to PKD)
b) Annex 1b: Borang Notifikasi Kes Gigitan Haiwan yang Membawa Penyakit Rabies
(PKD to Veterinary District Office)
c) Annex 2: Laporan Harian Kes Gigitan Anjing/Haiwan Liar
d) Annex 3: Carta Alir Notifikasi Kes Yang Terdedah Kepada Rabid Dog

2. Medical Response for human rabies/human exposes to rabid animals

2.1 GENERAL GUIDELINE FOR DOG BITE MANAGEMENT ACCORDING TO CATEGORY
OF EXPOSURE
RISK
CATEGORY
1

TYPE OF EXPOSURE

ACTION TO BE TAKEN

Touching/feeding animal.
Licking of intact skin.

Nil if history is reliable.

If history not reliable, treat as
category 2.

Nibbling of uncovered skin.

Superficial scratch, no bleeding.
Licking of broken skin.

Apply wound treatment.

Administer vaccine.
Do not administer anti-rabies
immunoglobulin.
Stop vaccination if animal is rabies
negative in laboratory tests, or
remains healthy after 10 -14 days
observation (dog or cat). Continue
vaccination if animal is not
found/captured.

Bites/scratches which penetrate the Apply wound treatment.

skin and draw blood.
Administer vaccine.
Administer
anti-rabies
Licking mucous membrane.
immunoglobulin.
Multiple bites.
Any wild animals bites
Administer
anti-tetanus
and
antibiotic treatment.
Stop vaccination if animal is rabies
negative in laboratory tests, or
remains healthy after 10 - 14 days
observation (dog or cat). Continue
vaccination if animal is not
found/captured.

2.2 POST EXPOSURE MANAGEMENT

Effective treatment soon (within a few days, but as soon as possible) after exposure to
rabies can prevent the onset of symptoms and death.
Post-exposure prevention consists of local treatment of the wound, administration of rabies
immunoglobulin (if indicated), and immediate vaccination.
2.2.1 LOCAL TREATMENT OF THE WOUND
Removing the rabies virus at the site of the infection by chemical or physical means
is an effective means of protection. Therefore, prompt local treatment of all bite
wounds and scratches that may be contaminated with rabies virus is important.
Recommended first-aid procedures include immediate and thorough flushing and
washing of the wound for a minimum of 15 minutes with soap and water, detergent,
povidone iodine or other substances that kill the rabies virus.

2.2.2 POST-EXPOSURE VACCINE (PEP) AND RABIES IMMUNOGLOBULIN (RIG)

PEP is given for risk category 2 and 3 accordingly. RIG is given for risk category 3
only.
a)

Area for injection for vaccine;

i.
ii.

Adult - IM at deltoid area

Children IM at anterolateral aspect of thigh

NOTES:
i.

b)

For children, gluteal area should never be used for rabies vaccine injections
because observations suggest administration in this area results in lower
neutralizing antibody titers.
Indication;

Vaccination after exposure (post-exposure) is recommended for all individuals who

have had contact with an animal (e.g., bites or abrasions) that they believe may be,
or which is proven to be, rabid.
c)

Doses;

The number of doses required is determined by the previous immunization status of

the individual
i) Previously unvaccinated people;
a) 4 doses at day 0, 3, 7, and 14.
b) In addition to rabies vaccine, these people should also receive a dose of RIG
at the same time as the first dose of the vaccine to provide rapid protection
that persists until the vaccine works.
ii) Previously vaccinated people - 2 doses at day 0 & 3 and RIG is unnecessary and
should not be given.
iii) Immunocompromised patient (corticosteroids, other immunosuppressive agents,
chloroquine, and immunosuppressive illnesses e.g. congenital immunodeficiency,
HIV, leukaemia, lymphoma, generalized malignancy)
a) 5 doses at day 0, 3, 7, 14 and 28.
b) In addition to rabies vaccine, these people should also receive a dose of RIG
at the same time as the first dose of the vaccine to provide rapid protection
that persists until the vaccine works.
IMPORTANT NOTES:
1. For Negeri Perlis, Kedah, Pulau Pinang, Kelantan and Perak: RIG is given for
risk category 3, multiple bites wound (priority to neck and head area) and dog
is not found/captured.

2. For other States (rabies non-infected States): Risk category 2 and 3 should be
assessed by ID Physician in hospital for commencement of PEP and/or RIG.
a) Animal is found/captured: Notify the nearest District Veterinary Office to
quarantine the animal. Start PEP and/or RIG if animal is sick or died
within 10 - 14 days of observation; and after consulting ID Physician in
hospital for further assessment of dog bite cases.
b) Stray animal: please consult ID Physician in hospital for further
assessment of dog bite cases. PEP and/or RIG will be given based on
the evaluation from the ID Physician.
2.3 Type of vaccine and Immunoglobulin in Malaysia
a) Verorab (PVRV - purified inactivated rabies vaccine, prepared on vero cell) Sanofi
Pasteur
b) Rabies Immunoglobulin (RIG)
The decision to give RIG must be individualized due to a global shortage. Decision to be
made after discussion with a person knowledgeable in rabies exposure management.
i.

Type of RIG
a) Equine RIG Dose: 40 IU/kg

ii.

Route of administration: IM at an anatomical site distant from vaccine

administration.

RIG should be given with the first dose of vaccine to promote clearance of infection by
neutralizes the virus before invasion of the nervous system. If possible, the full dose should
be infiltrated around any wound(s) and any remaining volume should be administered IM at
an anatomical site distant from vaccine administration.
Also, RIG should not be administered in the same syringe as vaccine. Because RIG might
partially suppress active production of antibody, no more than the recommended dose
should be given.
If immunoglobulin is not available, it can be delayed up to 7 days post 1st vaccine given.
Beyond the seventh day, RIG is not recommended since an antibody response to the
vaccine is presumed to have occurred.
2.4 Acute Dog Bite Case Management at Primary and Secondary Setting
i.

ii.

Primary Setting: clinical assessment, wound care and start antibiotic if wound
is dirty. Patient with risk category 2 or 3 should refer to casualty at
designated hospital. Patient with risk category 1 will discharge with advice (no
risk of rabies)
Secondary Setting: Casualty Team will assess and start PEP (day 0 with or
without RIG).
a.
Asymptomatic patient: Discharge with Home Alert Card and Rabies
Vaccination Certificate. Continue PEP if dog positive for rabies.

b.

Discontinue PEP if dog negative for rabies or dog still healthy after
10 - 14 days of quarantine
Symptomatic patient: Start PEP and RIG. Admission to ward
immediately.

2.5 Old Dog Bite Case Management

i.
ii.

Without wound: Discharge with advise (no risk of rabies)

With wound: Wound care, start PEP if patient was bitten less than 3 months
ago with status of the dog are unknown, dog vaccination are not valid or dog
die within 10 - 14 days of quarantine. Discharge with advice (no risk of rabies)
if patient was bitten more than 3 months ago.

2.6 Rabies Vaccine and Rabies Immunoglobulin (RIG) Stockpile

Vaccines are to be kept at the state hospitals. If required, vaccine can be redistributed. JKN
should give updated quantity of vaccine and RIG at the designated hospitals to Zoonosis
Sector, Disease Control Division, MOH in their daily report.
2.7 Health Education
Discharge asymptomatic patient should receive Patient Home Alert Card (Sample, Appendix
2) and Rabies Vaccination Card (Sample, Appendix 3).

3. Laboratory Criteria for diagnosis of human rabies

No tests are available to diagnose rabies infection in humans before the onset of clinical
disease. Several tests are necessary to diagnose rabies ante-mortem (before death) in
humans; no single test is sufficient. Laboratory confirmed case include one or more of the
following tests:
1.

Detection of viral RNA by RT-PCR in clinical specimen.

2.

Detection of rabies viral antigens by direct fluorescent antibody (DFA) or

immunohistochemistry (IHC) in clinical specimens, preferably brain tissue (post
mortem) or from skin or corneal scrapping/corneal touch impression (ante mortem).

3.

Isolation of rabies virus (Viral isolation, VI) from clinical specimen

4.

Detection by electron microscopy

Clinical specimens from the case/patient:

Saliva (RT-PCR, VI)

Skin biopsy of hair follicles at the nape of the neck (DFA, IHC, RT-PCR, VI)

Brain biopsy for post mortem cases (DFA, IHC, RT-PCR, VI)

Corneal scrapping/corneal touch impression (DFA, IHC)

CSF (antibody test).

Serum (antibody test).

Saliva: Use a sterile eye dropper pipette and dispense into a sterile container. Do not add
preservatives or VTM.
Skin biopsy: Should be collected at the posterior region of the neck at the hairline. A section
of skin 5 to 6 mm in diameter should contain a minimum of 10 hair follicles and be of
sufficient depth to include the cutaneous nerve at the base of follicle (viral antigen is found in
the nerve fibres surrounding the base of hair follicles). Place the specimen on a piece of
sterile gauze moistened with sterile water and place in a sterile container. Do not add
preservatives or VTM.
Brain Biopsy: Collect 5-6 mm in diameter, any part of the affected brain (they infect neurons
in almost all brain regions especially the horn of Ammon of the hippocampus, limbic areas,
brain stem, cerebellum and cerebral cortex) and place in a sterile container. Do not add
preservatives or VTM.
Corneal scrapping/corneal touch impression: This requires topical ocular anesthetic and is
best performed by an ophthalmologist. Corneal impression is obtained by pressing the
surface of sterile glass slide gently but firmly onto the cornea. For corneal scrapings,
epithelial cells are gently collected using a sterile loop or spatula and smeared carefully on a
sterile glass slide. Fix impression/smear in acetone.
CSF: 1-3 ml in sterile container. Do not add preservatives or VTM.
Serum: 1-3 ml in sterile container. Do not add preservatives or VTM.
The specimens (except for fixed smears) must be kept chilled during storage and transport.
Transport the specimens as quickly as possible to the laboratory.

Appendix 1

CARTA ALIR PENGURUSAN/TINDAKAN KES GIGITAN ANJING/

HAIWAN LIAR
Kejadian kes gigitan anjing/
haiwan liar di hospital/ klinik
kerajaan & swasta
Pengurusan Klinikal Kes:
(rujuk dokumen WHO)

Notifikasi kejadian gigitan oleh mana mana pengamal perubatan kepada

PKD melalui telefon/faks segera
(dalam masa < 24 jam) dengan
mengisi Annex 1a

a) Rawatan luka
b) Suntikan vaksinasi
Rabies jika ada
indikasi (PEP)
c) Suntikan anti-rabies
immunoglobulin jika
ada indikasi
d) Kemasukan ke wad
jika ada indikasi
e) Rawatan susulan
menurut keperluan

Siasatan segera oleh PKD dan

melengkapkan borang Notifikasi Kes Gigitan
Haiwan Yang Membawa Penyakit Rabies
(Annex 1b) dalam masa < 12 jam

JKN sediakan laporan harian ke

KKMsebelum 12.00 tengahari hari
berikutnya. Format laporan (Annex 2)

Notifikasi kejadian gigitan oleh PKD melalui

telefon kepada pihak JKN dan Pejabat
Perkhidmatan Veterinar (PPVD) berhampiran
dalam masa < 12 jam diikuti dengan faks
Borang Notifikasi Kes Gigitan Haiwan Yang
Membawa Penyakit Rabies (Annex 1b) kepada
PPVD

1) PKD perlu dapatkan maklumbalas Status Risiko Gigitan daripada PPVD

dalam masa < 48 jam; samada hasil siasatan awal PPVD mendapati:
a) Ada risiko Rabies
b) Tiada risiko Rabies
2) PPVD memberi maklumbalas segera kepada PKD sekiranya haiwan
dimusnahkan atau diletak dalam pemerhatian dan menunjukkan simptom
rabies atau pemakluman sebarang keputusan sampel haiwan

Notifikasi kejadian gigitan oleh PKD

kepada JKN. Mohon rujuk kepada
Carta Alir Notifikasi Kes Yang
Terdedah Kepada Rabid Dog /
Animals (Annex 3)

Annex 1a

HOSPITAL / KLINIK KERAJAAN & SWASTA

NAMA HOSPITAL/KLINIK KERAJAAN & SWASTA..
DAERAH
NEGERI ..
PEJABAT KESIHATAN DAERAH
DAERAH.
NEGERI ..
Tuan/Puan,
BORANG NOTIFIKASI KES GIGITAN HAIWAN YANG MEMBAWA PENYAKIT RABIES

NAMA PESAKIT
K/P
JANTINA
UMUR
BANGSA
NAMA IBU/BAPA
ALAMAT
NO LAPORAN POLIS
NO PESAKIT LUAR
JENIS HAIWAN
SILA TANDAKAN
( ) DALAM KOTAK YANG
SESUAI
TARIKH DIGIGIT
TEMPAT KEJADIAN
TARIKH & RAWATAN DITERIMA
MASA RAWATAN
NAMA PEGAWAI PERUBATAN
KES DIRAWAT SEBAGAI
ALAMAT HOSPITAL/KLINIK

BERTUAN ( )
YANG TIDAK BERTUAN (
BERLESEN ( ) TAK BERLESEN ( )
TIDAK DIKETAHUI ( )

PESAKIT LUAR (

) DIMASUKKAN WAD (

NOTA : Borang ini hendaklah diisi oleh pengamal perubatan yang menguruskan
kes gigitan anjing/haiwan liar (bagi setiap kes)

Annex 1b

PEJABAT KESIHATAN DAERAH

DAERAH
NEGERI ..
PEJABAT PERKHIDMATAN VETERINAR
DAERAH.
NEGERI ..
Tuan/Puan,
BORANG NOTIFIKASI KES GIGITAN HAIWAN YANG MEMBAWA PENYAKIT RABIES

NAMA PESAKIT
K/P
JANTINA
UMUR
BANGSA
NAMA IBU/BAPA
ALAMAT
NO LAPORAN POLIS
NO PESAKIT LUAR
JENIS HAIWAN
SILA TANDAKAN
( ) DALAM KOTAK YANG
SESUAI
TARIKH DIGIGIT
TEMPAT KEJADIAN
TARIKH & RAWATAN DITERIMA
MASA RAWATAN
NAMA PEGAWAI PERUBATAN
KES DIRAWAT SEBAGAI
ALAMAT HOSPITAL/KLINIK

BERTUAN ( )
YANG TIDAK BERTUAN (
BERLESEN ( ) TAK BERLESEN ( )
TIDAK DIKETAHUI ( )

PESAKIT LUAR (

) DIMASUKKAN WAD (

NOTA : Borang ini hendaklah diisi oleh pegawai kesihatan daerah bagi setiap
kes, dan satu salinan dihantar kepada JKN Negeri berkenaan.

Annex 2
LAPORAN HARIAN
KES GIGITAN ANJING/ HAIWAN LIAR
NEGERI:
DAERAH:

A. KEJADIAN KES GIGITAN ANJING

(1)
Bil
1.
2.
3.
4.
5.
6.
7.
8.
(2)
Bil
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.

Status kejadian kes gigitan anjing dilaporkan pada (tarikh)

Perkara
Bil. kes gigitan dilaporkan
Bil. kes gigitan mendapat rawatan pesakit luar
Bil. kes gigitan menerima suntikan Vaksin Rabies
Bil. kes gigitan yang dimasukkan ke wad
Bil. kes gigitan diambil sampel ujian Rabies
Bil. kes gigitan disahkan positif Rabies
Bil. kes gigitan mati
Bil. anjing terlibat dalam kes gigitan

Jumlah

Status kumulatif kes gigitan anjing (julat tarikh)

Perkara
Bil. kumulatif kes gigitan dilaporkan
Bil. kumulatif kes gigitan mendapat rawatan pesakit luar
Bil. kumulatif kes gigitan menerima suntikan Vaksin Rabies
Bil. kumulatif kes gigitan masih dalam susulan Rabies (PEP)
Bil. kumulatif kes gigitan telah tamat susulan Rabies (PEP)
Bil. kumulatif kes gigitan yang dimasukkan ke wad
Bil. kumulatif kes gigitan diambil sampel ujian Rabies
Bil. kumulatif kes gigitan disahkan positif Rabies
Bil. kumulatif kes gigitan mati
Bil. kumulatif anjing terlibat kes gigitan
Bil. kumulatif anjing terlibat kes gigitan berjaya ditangkap
Bil. kumulatif anjing terlibat kes gigitan diambil sampel
Bil. kumulatif anjing terlibat kes gigitan diambil sampel dan
disahkan positif Rabies
14. Bil. kumulatif anjing terlibat kes gigitan ditangkap dan diarah
kuarantin 10 hari
15. Bil. kumulatif anjing terlibat kes gigitan, diarah kuarantin 10 hari
dan telah tamat tempoh kuarantin.

Jumlah

B. AKTIVITI KAWALAN / PENDIDIKAN KESIHATAN

Senarai aktiviti kawalan / pendidikan Penyakit Rabies yang dijalankan
BIL AKTIVITI DIJALANKAN
1.

2.

C. MAKLUMAT VAKSIN RABIES/ RABIES IMMUNOGLOBULIN (RIG)

a) Vaksin:
Tarikh

Kuantiti Asal

Kuantiti
Tambahan

Kuantiti yang
digunakan

Baki

Kuantiti yang
digunakan

Baki

b) Rabies Immunoglobulin (RIG):

Human
Tarikh

Equine
Kuantiti Asal

D. ULASAN PEGAWAI

Dilaporkan oleh:
Tandatangan :
Nama:
Jawatan:
Tarikh:

Kuantiti
Tambahan

Annex 3
CARTA ALIR NOTIFIKASI KES YANG TERDEDAH KEPADA RABID DOG /
ANIMALS
PKD menerima kes gigitan anjing/
haiwan liar daripada hospital/ klinik
kerajaan & swasta

Tanda
Klinikal
penyakit
rabies
Kes menunjukkan tanda
klinikal penyakit rabies

PKD Notifikasi melalui e-notifikasi

dan mengisi Borang Notis: Rev/2010
NOTIFIKASI PENYAKIT
BERJANGKIT YANG PERLU
DILAPORKAN dibawah
PERATURAN-PERATURAN
PENCEGAHAN DAN
PENGAWALAN AKTA
PENCEGAHAN DAN
PENGAWALAN PENYAKIT
BERJANGKIT 1988 PENYAKIT
BERJANGKIT (BORANG NOTIS
(PINDAAN) 2011
(Diagnosis Penyakit : 28. Rabies)

Kes tidak menunjukkan tanda klinikal

penyakit rabies,
TETAPI
mempunyai sejarah risiko
pendedahan kepada gigitan
anjing/ haiwan liar yang disahkan
penyakit rabies oleh Jabatan
Perkhidmatan Veterinar (JPV)

PKD Mengisi Borang Notis: Rev/2010

NOTIFIKASI PENYAKIT BERJANGKIT YANG
PERLU DILAPORKAN dibawah PERATURANPERATURAN PENCEGAHAN DAN
PENGAWALAN AKTA PENCEGAHAN DAN
PENGAWALAN PENYAKIT BERJANGKIT 1988
PENYAKIT BERJANGKIT (BORANG NOTIS)
(PINDAAN) 2011
(Diagnosis Penyakit: 45. Others: Please specify:
Human exposed to rabid dog/animal)
*sesalinan Borang Notis: Rev/2010 yang telah
dilengkapkan perlu dihantar kepada Sektor
Zoonosis, Bahagian Kawalan Penyakit, KKM;
e-mel: zoonosis@moh.gov.my atau
faks: 03-88891013

Appendix 2

Appendix 3